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School Based Growth Tracking of Haitian Children

Friday, October 19, 2012
Room R06-R09 (Morial Convention Center)
Michael Bouton, M.D, Majed Aljohani, M.D, Srihari Cattamanchi, M.D and Greg Ciottone, M.D, Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA


Childhood malnutrition has serious lifelong effects including poor health, increased absenteeism from school and decreased life-time income. The Millennium Development Goals (MDG) put forth by the United Nations have largely been adopted by the international aid community as the standard against which to gauge progress. The first MDG is to half the proportion of people who suffer from hunger and one of its essential indicators is the prevalence of severely underweight children under the age of five. Childhood growth tracking is a simple, non-invasive means of gauging nutritional status and identifying those most in need of medical attention.

Our study assessed rates of stunting, underweight and wasting as a proxy for nutritional status among school children in Grand Goāve, Haiti. In this area there is a lack of medical care, with basic services ranging from de-worming to clean water not routinely available.


This study included 108 children aged 0-59 months old at the Mission of Hope School and Orphanage in Grand Goāve, Haiti. As part of the standard pediatric assessment, date of birth, gender, height and weight were recorded from November 2011 to April 2012. Data was entered into emergency nutrition assessment (ENA) software that uses the World Health Organization (WHO) growth chart to calculate z-scores of weight for height (wasting), height for age (stunting) and weight for age (underweight). Z-scores more than two standard deviation below the mean were classified respectively as wasted, stunted or moderately underweight and more than three z-scores below the mean as severely wasted, severely stunted or severely underweight.


The mean z-score for weight for height was -0.24±1.08 SD with 2.8% (3) (-0.3- 6.0 C.I.) wasted and classified as suffering from acute malnutrition. The mean z- score for height for age was -0.54±1.72 with a 14.3% (15) (7.6-21.0 C.I.) prevalence of stunting including 6.7% (7) (1.9-11.4 C.I.) severely stunted. Weight for age mean z score was -0.49±1.20 with a 7.4% (8) (2.5-12.3 C.I.)  prevalence of underweight and 3.7% (4) 0.1- 7.3 C.I.)  of children severely underweight.


Children in Grand Goāve, Haiti at the Mission of Hope School and Orphanage are more likely to be malnourished than age and gender appropriate matches. In a well-nourished population, 0.1% of children are severely underweight (<3SD below mean) and in our population 3.7% of patients met this definition with a confidence interval that did not cross into the normal range. We are implementing a basic pediatric care system including school based de-worming, micronutrient supplementation, targeted feeding and chlorinated water because each of these interventions has proven impact. We will continue to perform longitudinal growth tracking with special attention to severely underweight children and the first MDG.